Treating blood clots as a "never event" under pay-for-performance guidelines doesn't reflect reality, says a researcher who is calling for a re-evaluation of venous thromboembolism outcomes and process measures.

Just-released audits on Medicare risk adjustments by HHS and the Department of Justice in 2008 show significant problems with billing-related risk score calculations that were used for beneficiaries of plans operated by Aetna Health, Independence Blue Cross of Pennsylvania, and Care Plus, a division of Humana.

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Treating blood clots as a "never event" under pay-for-performance guidelines doesn't reflect reality, says a researcher who is calling for a re-evaluation of venous thromboembolism outcomes and process measures.

Sen. Ron Wyden (D- OR), ranking member of the Senate Finance Committee, identifies four areas in which Medicare could be a leader in clinical care, while Rep. Kevin Brady (R-TX), chairman of the House Ways and Means Health Subcommittee, says the focus should be on efficiencies. From MedPage Today.

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